Sussex Partnership NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We rated well-led as good. Managers ensured staff received training, supervision, and appraisals. There were good opportunities for growth and career development. Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions. The service managed access to beds well and discharged patients promptly once their condition warranted this.

However, there were also areas in which the provider needed to improve. Some agency and bank staff had not received a full induction and orientation of the wards before being deployed to work on them. Mental capacity assessments for patients were not always completed or recorded appropriately. Consent to treatment (T2) authorisations were not always completed. Incidents were mentioned in care notes but not always reported on the provider’s electronic incident reporting system. We raised these concerns with the provider on the day of our assessment and the provider gave us written assurance and an action plan of what they were doing to mitigate these problems. As part of the short-term mitigation plan, the provider took decision to supervise patients to use bathrooms on Regency ward until ligature risks were fixed. The provider proposed to reduce bed numbers by two and put a hold an admissions whilst addressing these concerns.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us the senior leadership team had successfully communicated the provider’s vision and values to all staff. For example, the provider had a vision to reduce length of stay for patients, reducing restrictive interventions and had plans to refresh the Safewards approach. These plans were shared with staff through staff induction and improvement programme, away days, and ward team meetings. Staff told us senior managers were visible, approachable, and responsive to the service’s needs. Some staff believed leaders were committed to improving standards of care and treatment for all patients and believed the service had a strong support team. However, 6 staff members, gave mixed feedback about the culture within the staff and management team. For example, staff gave mixed feedback about their confidence in raising concerns regarding dismissive, or discriminatory behaviour of some managers without fear of the consequences.

Managers told us the provider planned to bring their capital work forward to enable them to change both Caburn and Regency to mixed-sex accommodation. However, following a review by the sexual safety group the provider put a pause on the plan to modify the wards on 29 May 2024. The provider told us they would re-consider the evidence and the rationale to change the wards into mixed- sex wards.

The provider had a vision to reduce the length of stay, reduce restrictive interventions, ensure the provider was following restrictive interventions guidance and to be able to provide outstanding care.

Leaders of the ward had experience of working in acute inpatient mental health services. During our assessment, the leaders demonstrated a good understanding of patients, the staff team and all matters relating to the provision of an acute ward services. The manager was present on the ward and had a good understanding of all the patients’ needs and circumstances. The manager told us they received support from an experienced management team at the hospital. Staff said their manager was supportive and the team had good relationship with each other, very supportive of each other and were very compassionate. Staff received feedback from managers during supervision sessions and had annual appraisals, in which the manager discussed personal development plans. Some staff spoke about a positive work culture in the team and a good relationship with managers. Staff told us their ward managers were warm and welcoming. However, 4 staff told us the senior management team were not always compassionate and sometimes blamed the nursing team for serious incidents that happened on the wards. Staff told us there was a blame culture within the organisation.

Minutes of daily operations meetings indicated that staff discussed all relevant issues to ensure safe care and treatment including allocation of patient observations, and the current physical and mental health needs of patients.

Staff told us they were aware of the freedom to speak up guardian (FTSUG) and knew how to access this service, should they need to. Staff told us FTSU came to the ward to give them their cards and information on how to contact them. Manages told us staff were encouraged to approach mangers and to raise concerns when necessary. We received mixed feedback from staff regarding their ability and willingness to raise concerns about the service. Some staff told us they felt safe to raise any concerns with their immediate management team if they had to and they felt their concerns was appropriately resolved. However, others told us they felt isolated and not much was done to support them when they raised concerns with the senior management team. For example, 2 members of staff told us they raised concerns about the management’s plan to change the wards into mixed sex wards but their concerns did not change anything.

Staff told us and we saw Freedom to Speak Up Guardian information was displayed on the information board in the staff room. Staff knew how to use the whistle-blowing process and about the role of the Speak Up Guardian.

The manager told us the provider introduced staff wellbeing to ensure staff were well supported to handle verbal abuse from patients. Staff reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression.

One member of staff told us staff morale was low because staff did not always feel supported by the senior management team. One member of staff told us they had seen a colleague sitting in the treatment room and crying because they did not feel supported by their manager. Another member of staff told us staff sometimes felt stressed with the work and that staff wellbeing was not always important to the senior managers.

The provider offered a range of career pathways and development opportunities for managers, nurses, and health care support workers (HCSW). Staff told us the provider gave them an equal opportunity to develop themselves. For example, the provider offered continuous professional development (CPD) courses that staff had access to such as senior health care support worker apprenticeship which was available to existing members of staff and was delivered internally. The provider offered a registered nursing associate pathway which was available for existing health care support workers and offered externally to staff who wanted to join Sussex Partnership. The provider also offered registered Nurse Degree Apprenticeship which allowed apprentices from Sussex Partnership to qualify and register as a mental health nurse with the Nursing and Midwifery Council.

Consultants and doctors engaged in peer review meetings and had discussions with other colleagues and attended Medical advisory community meetings (MAC). Doctors were members of speciality and special doctors peer review group. Ward managers told us the provider gave them the opportunity to develop themselves by offering them a range of developmental. Managers had completed a national autism and reasonable adjustment for autistic patients training programme.

Managers had not always ensured care plans and risk assessments were appropriately audited to ensure they contained known risks of patients. For example, one patient at risk of self harm did not have a care plan which detailed what measures staff took to reduce the risks such as what items they could or could not have in their room.

Managers had not always ensured care plans for medicines were in place for patients. Care plan information to support staff to recognise known physical health risks of medicines such as with clozapine and lithium was missing. Staff we spoke with were not aware of the risks that were associated with the use of these medicines. For example, a patient on clozapine did not have a care plan in place for staff to be aware of these risks.

Care plans were not clearly updated following incidents. For example, we found that care plans for three patients were not updated immediately following incidents.

Managers had not ensured that incidents were reported appropriately. We found three incidents where neither the nurse nor the medical person had recorded the incident on the provider’s incident reporting system.

Managers did not ensure consent to treatment (T2) documents were always completed. For example, there were no copies of consent to treatment paperwork with the prescription charts on Regency ward.

Managers did not always have good oversight of agency/ bank staff induction and orientation of the service. For example, some agency and bank staff had not received a full induction and orientation of the wards before being deployed to work on the wards. Some staff did not have awareness of the environmental risks.

We raised our concerns with the management team during our feedback session, and we received assurance of the immediate actions the provider would take to mitigate the risks.

The provider had systems in place to check performance and compliance with the assessment, planning and evaluation of patients’ care and treatment. Managers completed a range of audits to ensure that the service was safe and effective such as clinical audits, client involvement and client file audits, risk assessment and care plan audits, and medicines audit. The manager had audit checklist pasted on the manager’s office board to monitor various audits that had to be followed up and completed by them. Managers attended full monthly Millview acute governance meeting where audits were presented to the leadership team.

The provider assured us safety huddles were taking place and included discussion of recent incidents.

The provider assured us relevant capacity assessments and consent to treatment forms were being printed out for all Caburn ward and Regency ward patients’ drug charts. Consent to treatment documentation were present on drug charts and would be audited weekly by the nursing team with immediate effect.

The provider confirmed Millview leadership team were reviewing the local induction for temporary staff and was last updated in 2022. A draft copy of the plan was shared with CQC during the site visit. The provider said they were implementing learning from recent improvements made by one of their services in Millview hospital. This updated induction plan for Millview will be completed by 21st June 2024.

The leadership team attended a monthly full Millview acute governance meeting, where the team were presented with and discussed various audits. For example, the quality and governance group met monthly to review level 3 and level 4 risks on the provider’s risk register. The managers reviewed environmental issues and looked at patients’ admissions audit as well as engaged in weekly action plan reviews

Patients told us the provider supported them to keep in touch with their GPs and care coordinators and the community teams.

Staff told us the provider had good partnership working with other services such as the local authority, the substance misuse services, community mental health teams, the Royal County hospital and the police department.

The MDT team at Caburn ward received a compliment from an external organisation for providing excellent support to a patient with specific communication needs.

Managers held an outlier meeting to consider barriers to patient discharges. We reviewed documents which showed that managers held patient flow meetings on Tuesdays and held escalation and multiagency discharge events (MADE) to discuss patient discharge. Managers told us the difficulty in finding accommodation for some patients formed a barrier for patients discharge which sometimes increased the length of stay on the wards. The provider was developing a structured care pathway to try and ensure there was more standardisation within the service and had appointed new trust-wide clinical director for patient flow to oversee the discharge pathways.

The hospital management team were committed to continuous improvement of the service. There was a focus on recruitment and retention and providing training for staff. Managers told us they were in the process of implementing ‘Safewards’ policies within the service and share lessons learnt.

The management was focused on making Regency ward more autism friendly. Caburn ward had a newly built sensory room which was built using funds raised by staff and patients.

The hospital was also improving patient flow access on both Regency and Caburn wards.

The leadership team were very proactive in identifying learning and making changes. For example, an improvement board was set up with the executive team’s support and leadership to provide the team with learning and improvement.

The team was engaged in quality improvement (QI) and held QI huddles once a week. The provider had also started working on staff wellbeing and considering how well to support the team. The managers were planning a nurse development day where nurses would go through the reasons why incidents happen. The provider also had plan for a team away day where the physical health team would train the staff on physical health monitoring as well as giving the staff a refresher training on safeguarding.

The management recognised areas of concerns and established a Regency ward weekly improvement plan meeting which was reviewed and chaired by the chief nursing officer. The manager told us the wards had a practice nurse educator who provided support to new nurses and held support group every other week.

At the time of this assessment, the team at Regency ward were going through quality improvement to establish the problems on the ward and to put systems in place to deal the problems. The team focussed on safety huddles.

We saw evidence that the hospital had implemented a quality improvement action plan to address racial abuse from patients towards staff and other patients and had improved monitoring and implemented actions to reduce the number of incidents. The trust had identified aspects of closed cultures in the acute wards and completed an internal review to reduce issues associated with closed cultures. The internal review identified the need to develop therapeutic observation, assessment and physical health monitoring of patients and to improve professional standards. This included the need to improve on staff dress code and the need to role model professional behaviours and to maintain professional boundaries with patients.